Posted on Feb 06, 2020
Children’s Mental Health Week takes place on 3-9 February 2020 - Jayne Carlisle, tutor has produced some articles aimed at raising awareness of the impact of mental ill-health on development and life chances.
Attachment and co-regulation
What is attachment, what are the influences and why does this matter?
Whilst early behavioural theories explain attachment as a process that occurs when a child is fed, or nourished by carers, and is a learned behaviour, we now know that attachment is a strong emotional bond that has an enormous impact that continues throughout life. Today, we know that the key to attachment is being available to our child, and responding to their needs, which helps them to develop a sense of security in knowing their carer is dependable, creating a secure foundation from which the child can explore their world, impacting behaviour and functioning, and later relationships in life, leading to high self-esteem, and the ability to cope. Indeed, research shows that children with secure attachments do better in schools, whilst failing to form an attachment can impact behaviour in childhood and increase the likelihood of experiencing stress or anxiety, or depression, which continues throughout life.
What is co-regulation?
Co-regulation is the supportive relationship between a child and their carers that leads to the capacity for self-regulation, which is recognised for its role in promoting wellbeing throughout life, by controlling our emotions which is the foundation for educational achievement, physical and emotional health. Physically, a child’s nervous system interacts with another person’s nervous system in a way that drives greater emotional balance and physical health. It facilitates the process of evaluating our emotional response and deciding how to respond. This development is however reliant upon predictive and supported environments. Regardless of our role, responding to a child’s needs sensitively and warmly can ameliorate the impact of adverse experiences.
Whilst adolescence will mean that children may developmentally separate from their carers, seeking more independence, they need carers who are available to provide support during times of conflict, and to teach coping skills for stressful situations; they need opportunities to make decisions, and to be supported to make positive choices. Because good self-regulation fosters positive outcomes in relation to educational achievement, income, and life chances, decreasing long-term health costs, investing in co-regulation can help us in building resilience, and developing positive lifestyles for our children.
Babies Don’t Keep
Mother, O Mother, come shake out your cloth, Empty the dustpan, poison the moth, Hang out the washing, make up the bed, Sew on a button and butter the bread.
Where is the mother whose house is so shocking? She’s up in the nursery, blissfully rocking.
Oh, I’ve grown as shiftless as Little Boy Blue, Lullaby, rockabye, lullaby loo. Dishes are waiting and bills are past due Pat-a-cake, darling, and peek, peekaboo
The shopping’s not done and there’s nothing for stew And out in the yard there’s a hullabaloo But I’m playing Kanga and this is my Roo Look! Aren’t his eyes the most wonderful hue? Lullaby, rockaby lullaby loo.
The cleaning and scrubbing can wait till tomorrow But children grow up as I’ve learned to my sorrow. So quiet down cobwebs; Dust go to sleep! I’m rocking my baby and babies don’t keep.
Author: Ruth Hulburt Hamilton
All children are capable of achieving great things; there is no gene responsible for happiness, this potential is in all children. We can’t deny, children will face challenges, but what we can do is equip our children with the skills to deal with these challenges. What we can do is help our children build their resilience, to help them to remain mentally healthy, during times of adversity. Whilst being resilient won’t make problems go away, being resilient means being able to see past the problems or reach out to others; it means having the strength to cope with factors such as bullying or trauma and provide protection against mental health conditions such as depression. Being resilient means being able to adapt to life’s challenges, whereas lacking resilience can lead to unhealthy methods of coping with adversity, or being overwhelmed, and an increased likelihood of experiencing long term mental health conditions such as depression.
What is resilience?
Borrowed from engineering to describe a piece of material that is able to withhold external stress due to hardness, strength, and flexibility, in psychiatry, resilience describes an individual’s ability to cope with stress and adversity. Whilst often described as being able to ‘bounce back’, following difficult circumstances such as bereavement or abuse, resilience is much more than this, it is the ability to cope with adversity whilst remaining mentally healthy.
How does resilience affect behaviour?
We all have different levels of resilience, and ways of addressing, responding, and recovering from adversity. Children will also have different ways of showing their inability to cope. Some become emotional whereas others may become angry. All children experience days when they are unable to cope but low resilience will certainly increase patterns of negative behaviours more frequently.
Physically, when children experience adversity or stress, the body compensates by making us stronger and more alert. The heart pumps faster, increasing blood pressure and the stress response is initiated by the amygdala in the brain, sending messages to release adrenaline and cortisol to help the body deal with adversity, however, adversity can also cause the control tower of the brain, the prefrontal cortex, which is involved in emotional regulation, to shut down. Being resilient relates to the ability to activate the prefrontal cortex and calm the amygdala, reversing the physiological changes, increasing the ability to recover from, or adapt to adversity. Worryingly, if the amygdala is not calmed, the physiological effect remains, and over a period of time, can weaken the immune response in addition to making us insulin resistant. This is one of the reasons children often become ill when they are stressed, for example during exam times.
So how can we build resilience in children?
As this report shows, there is a clear relationship between resilience and emotional regulation. During childhood, our nervous system is dependent upon others to help us to feel safe and secure (co-regulation). Our sense of self is developed through the quality of care received, helping us to learn emotional expression. However, unresponsive parenting, trauma, or abuse can lead to emotional dysregulation, which impacts the ability the calm a child or make them feel safe, leading to long term patterns of emotional distress. Research shows that it’s not determination or strength that supports children through adversity but at least one supportive relationship that helps a child develop coping skills and reverse the physiological impact of stress or adversity. Anyone in a child’s life can make a difference, parents, carers, family or teachers. Building connections with the people who love them will strengthen them. Teach them how to solve problems. We must encourage our children to work out how to handle challenges; help them to learn what works, and what doesn’t. After all, life is all about solving problems.
As parents, carers, or teachers, we all want to protect our children from all harms. However, we know that threat and adversity cannot be eliminated. We all want our children to deal with stress and cope with adversity. We all want our children to be resilient. Resilience can help children survive severe disadvantage and emerge relatively unharmed.
Children in Crisis
One in ten children aged 5-16 experience mental health problems increasing to 1/5 of young people aged 16-19, including depression, anxiety, and mood disorders. This equates to 3 children in every classroom. Serious mental health problems can reduce life expectancy by between 15 and 20 years and children with emotional disorders are more likely to smoke, drink or take drugs, or self-harm, than other children, and are less likely to achieve educationally or secure well-paid employment as adults.
No child is immune to a mental health problem, no matter what their background or life experience and whilst most children can cope with life’s stressors, adverse experiences can cause difficulties for some young people, especially for children who are vulnerable. Babies who do not have a strong bond with their carer’s are at an increased risk of developing mental health problems.
In the same sense that physical health problems can have a range of causes, including biological, psychological and social factors, risk factors mean some children may be at a greater risk of developing a mental ill-health condition including those who have been bullied, have a family member with a mental health condition, those who experience bereavement, or are living in poverty. Children and young people living in poverty are three times more likely to experience mental health problems than those from more affluent homes.
Self-harm is the term used to describe someone who harms or injures themselves purposely. However, in the majority of cases, children self-harm as a way of coping rather than ending their life and it is often an attempt to find relief from an overwhelming situation or an attempt to communicate the need for help, with others. Whilst the purpose of self-harm is generally to preserve life, some children who repeatedly self-harm do attempt suicide so repeated incidents should be considered a risk factor. Some children who self-harm may kill themselves by accident.
24,000 children aged 10-19 attempt suicide each year and although females are more likely to attempt suicide, twice as many males die following suicide. Suicide is the most common cause of death for males aged 5-19, contributing to 14% of deaths in this age band and the second most common cause for females at 9%. In 2018 542 deaths in males aged 10-24 were attributed to suicide and the rate among females aged 10 to 24 years, showed an increase to 3.3 per 100,000 in 2018 (188 deaths). Statistics show almost 100 children aged 10-14 have killed themselves in the past ten years (ONS, 2018*). Most of the young people who died were not known to specialist services such as CAMHS, or Social Care.
Any child or young person, who expresses thoughts about suicide, must be taken seriously and appropriate help and intervention should be offered immediately. If a young person tells you they want to take their own life, do not leave them alone. Take all comments seriously. Listen to the child and be non- judgemental. Choose your words carefully. Do not dismiss their comments and never promise to keep secrets. Never dismiss this as attention-seeking behaviour.
GPs play a significant role in the prevention, and management of mental health in children and young people. The Police will respond when there is an immediate risk of suicide or serious self-harm. In such an emergency, the police should be called on 999. The Police are able to use their powers of Police Protection under The Children’s Act 1989 or utilise s.146 of the Mental Health Act to detain any person who is at significant risk of harm. If a child or young person is at risk of significant harm (S47 Children Act 1989) you have a duty to share concerns and information relevant to the risk.
Useful Contacts Childline 0800 1111 www.childline.org.uk
Mindinfoline 0845 766 0163 http://www.mind.org.uk/information-support/
NHS Direct 111 www.nhsdirect.nhs.uk